Olivia Bennett*, four years old, has always been tall for her age. She has a curious mind, an advanced vocabulary and an extremely well-developed imagination. In most ways, she’s very similar to her classmates in junior kindergarten, but it’s not uncommon for Olivia to be mistaken for a much older child. Her parents, James* and Clarissa* never suspected anything concerning her rapid development (which has been evident since birth), but a routine doctor’s visit changed that.

“When Olivia was three, we took her to the doctor because of a nagging cough and cold that wouldn’t go away,” says Clarissa. “Our pediatrician brought to our attention Olivia’s breast development (which we just assumed was baby fat) and ordered some blood work.”

It turned out that Olivia’s hormone levels were in the normal range for a 12-year-old girl. A bone density test also showed that Olivia had the bone density of a six-year-old. After a referral to the endocrine unit at SickKids Hospital and a few more tests, Olivia was diagnosed with precocious puberty (PP).

Precocious puberty is a medical condition (most common in girls) where puberty starts outside of the range of normal puberty and moves quickly. When most girls begin puberty between seven and 13 years of age, what could cause such an early start?

Symptoms and treatments

For the majority of girls, causes for precocious puberty can include brain injuries, an infection (such as meningitis) or an imbalance in the thyroid gland that triggers the onset of puberty ahead of schedule. Symptoms often include breast development, a rapid growth spurt and/or mature body odour.

Dr. Jean-Pierre Chanoine is a clinical professor of Pediatric Endocrinology at British Columbia (BC) Children’s Hospital and has worked with and treated many families over the years, educating on some of the risks associated with precocious puberty diagnoses.

“Girls who tend to start their puberty earlier have less time to grow,” says Dr. Chanoine. Once precocious puberty is diagnosed, the goal of treatment is to stop or even reverse sexual development, rapid growth and bone maturation. Normal puberty includes a final growth spurt, after which girls mostly stop growing. If that growth spurt starts too early then it ends early, too, and a child will have fewer growing years in total.

If your child’s doctor determines that treatment is necessary, the most common medication is known as GnRH analog, a modified form of one hormone that kickstarts puberty. “It’s a treatment that works quite well, and [requires] an injection once every three months,” says Dr. Chanoine.

How to cope

Coping with a toddler’s medical condition would be challenging for any parent, but it can be particularly difficult explaining a medical condition like precocious puberty to a child under the age of five.

“You can certainly explain to your daughter why her body is changing, and that it’s just happening earlier than for other girls,” says Dr. Chanoine. Talk to you doctor if you suspect your daughter may be experiencing puberty too soon and give her a simple, truthful explanation about what’s happening.

“My advice to other parents going through this is to stay strong for your child,” says Clarissa. “They are going through something they don’t necessarily understand, but as Olivia gets older I think she’ll begin to realize that not everyone grows at the same rate and that’s OK.”

Girls versus boys

Just like normal puberty, the symptoms vary for girls and boys with precocious puberty. Note: Precocious puberty is quite rare in boys under the age of six, so be sure to talk to your doctor if you suspect anything out of the ordinary.

Symptoms for girls:

  • breast development
  • pubic or underarm hair development
  • a growth “spurt”
  • start of menstruation
  • acne
  • mature body odour

 Symptoms for boys:

  • enlargement of the testicles or penis
  • pubic, underarm or facial hair development
  • rapid height growth
  • voice deepening
  • acne
  • mature body odour

Who is at risk?

According to the Mayo Clinic, the following factors can increase the risk of precocious puberty:

  • being a girl (girls are more prone than boys)
  • being a person of colour 
  • being significantly overweight or obese
  • being exposed to sex hormones (through estrogen or testosterone found in adult ointments or creams)

Originally published in ParentsCanada magazine, Spring 2017.